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Human immunodeficiency virus (HIV) type 1 (usual kind) and type 2 (West African kind) nearly always results in skin changes. Recognising that atypical or severe cutaneous infections and other skin conditions may be related to underlying HIV infection allows initiation of early retroviral treatment and reduces the risk of transmission. It is estimated that there are at least 30 million infected individuals worldwide (2005).
Infection may arise through sexual intercourse, injection (especially illicit drug use), transplacentally or by breastfeeding.
HIV affects the skin because of the depletion of CD4+ cells (helper T lymphocytes), facilitated by initial infection via Langerhans cells in mucosal tissue. Viraemia appears within a few days and is initially controlled by specific immune response including CD8+ cells (cytotoxic T lymphocytes) and soluble cytokines.
Cutaneous manifestations are numerous. Detailed descriptions are found elsewhere in the course or on other online resources. In general, the presentations resemble more typical infections or dermatoses but are more florid, persistent and resistant to treatment.
Primary HIV viraemia:
Hair and nail problems:
HIV infection is diagnosed by positive ELISA screen confirmed by Western blot, immunofluorescent assay or viral load assay. Viral load assays are used to evaluate the effectiveness of antiviral treatment. PCR and viral culture are sensitive but expensive and difficult to perform.
The ratio of CD4+/CD8+ T cells is decreased.
Suspected infections can be identified and cultured in the usual way. Histopathology may be necessary.
Infections nearly always require oral treatment.
Kaposi sarcoma is treated by localised destruction, systemic chemotherapy, interferon and antiretrovirals.
Refer the patient to an infectious disease expert for antiretroviral therapy.
Describe the effects and complications of antiretroviral therapy.
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